title: Working the night shift: a necessary time for training or a risk to health and safety?
abstract: The European Working Time Directive (EWTD) limits excessive night shifts and restricts the working week to no more than 48 hours. The underlying rationale is to minimise the health risks to all workers. Here we debate the impact of night rotas for doctors-in-training on patient safety and medical education; when the EWTD was agreed these topics may not have been considered, either systematically or objectively. The impacts of diurnal rhythms on human functions affect all night workers, but the nature of rostered medical and surgical work has little precedent in other industries or even in the contracts of other healthcare staff. For example, rostered night duties need to be distinguished from permanent night shift work. On-call medical night work from training doctors is generally required for short periods and usually involves fewer patients. It is an important time in training, where clinical responsibility and decision-making can be matured in a supervised setting. To comply with the EWTD most hospitals have adopted rota patterns that aim to cover the clinical needs, while ensuring no doctor works for more than 48 hours in an average working week. To monitor this process longterm studies are necessary to evaluate effects on a doctor's health and on patient care generally. The EWTD has also led to a loss of continuity of patient care; does this really matter?
authors.affiliation: I Morrison, Department of Neurology Ninewells Hospital Dundee DD1 9SY. ian_m@doctors.org.uk. RJ MacFadyen, Ballarat Base Hospital PO Box 577, Ballarat 3353 Victoria, Australia. Robertmac@bhs.org.au.
authors.forename: I
authors.initials: I
authors.lastname: Morrison
authors.forename: D
authors.initials: D
authors.lastname: Flower
authors.forename: J
authors.initials: J
authors.lastname: Hurley
authors.forename: R J
authors.initials: RJ
authors.lastname: McFadyen
mesh_terms: D002940:Circadian Rhythm; D003266:Continuity of Patient Care; D005060:Europe; D005221:Fatigue / Q000517:prevention & control; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration; D019300:Medical Errors / Q000517:prevention & control; D008505:Medical Staff, Hospital / Q000458:organization & administration*; D010561:Personnel Staffing and Scheduling / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D012892:Sleep Deprivation / Q000209:etiology / Q000517:prevention & control; D006113:United Kingdom; D014940:Work Schedule Tolerance
keywords: Circadian rhythms; Sleep-wake biology; hospital night shift rotas; light-dark cycles; medical decision-making; sleep deprivation